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About 700,000 adults between ages 26 and 49 will be eligible as of Jan. 1
California will welcome the new year by becoming the first state to offer health insurance for all undocumented immigrants.
Starting Jan. 1, all undocumented immigrants, regardless of age, will qualify for Medi-Cal, California’s version of the federal Medicaid program for people with low incomes.
Previously, undocumented immigrants were not qualified to receive comprehensive health insurance but were allowed to receive emergency and pregnancy-related services under Medi-Cal as long as they met eligibility requirements, including income limits and California residency in 2014.
For us non-US readers; what’s the difference between health insurance and healthcare? For comparison, in Australia private health gives you a room, nice TV, edible food etc but you don’t get priority. When it comes to essential surgery or treatment you join the line with everyone else.
Health insurance is the system we use to pay for healthcare. Insurance is made available by your employer, you then pay premiums in order to buy and keep your insurance, and once you actually need healthcare, your insurance helps cover some of the costs of receiving care.
Everyone in the states needs health insurance, not because of how affordable it makes taking care of emergencies, but because, if you don’t have insurance, you have to pay the prices that the medical provider and insurance companies made up on how much procedures cost, so they can give each other a discount on those insane prices.
For instance, if you have insurance in the states and you go to the hospital for a nasty fall that maybe broke something. Nothing was broken, but they had to take x-rays. Well, you have to pay for the x-rays, and the time that the staff was needed for you. We’re going to pretend, for this case, that your insurance won’t deny coverage since it “wasn’t medically necessary”. So you’d get a bill between $200-$300.
But if you didn’t have insurance, or were denied coverage, you have to pay full price. But that price isn’t the price that anyone actually pays unless they’re in your predicament. You see, the provider and insurance had gotten together to determine how much would be paid for any given procedure, but they make the deal seem much better to their respective bosses by inflating the price of the procedure before negotiations, so that the insurance pays a “discount” that’s similar to the actual cost of the procedure. Which is great for them, but if you get treatment without insurance (or your insurance denies coverage) you have to pay the fake, inflated price that the provider said it cost before they negotiated the price back down to something reasonable with the insurance companies. So, to go back to my example above, those x-rays and some time with staff that didn’t lead anywhere will probably cost you more in the neighborhood of $2000-$3000 if you aren’t covered.
This has a double cooling effect. One, it forces more people to have health insurance out of fear of paying those stupidly insane prices. And two, it makes people avoid going to the doctor for minor issues for fear of being denied coverage since “it wasn’t medically necessary”. Great for profitability, terrible for humans.
Let’s not forget that the premium is usually taken from your paycheck, and can range from $15-$750/pay cycle depending on the insurance plan. In my case, I’m paying $450/month as the premium, plus $90/visit. The healthcare system doesn’t have an office near my home, so I travel an hour and a half to see the doctor, and it’s 45 minutes to the nearest hospital.
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For reference, I was in a car accident that broke both of my wrists and I had to go to the ER. I was fine other than my wrists.
The ER use for about… 3 hours? Was over $10,000. Because my health insurance refused coverage since it was in an auto accident.
Luckily my bodily injury coverage on my insurance paid.
Then I needed surgery and physical therapy. All of which were not covered by my health insurance.
The surgery was about $32,000. (Included the metal plates and screws/pins as well as the surgical room and recovery + surgeon and anesthesia).
All said and done total cost for having my wrists broken was about $70,000. None of which was covered by my health insurance and thank god my parents (I was still on their car insurance) paid for underinsured motorist coverage because the drunk that caused the accident didn’t have insurance. I didn’t go into debt ONLY because of that coverage.
They charged me $40 for 2 Tylenol they gave me in the ER while I waited for them to come set my wrists and give me the big girl pain killers. $18 for a pregnancy test too prior to surgery that I couldn’t refuse. Unreal.
The crazy thing is that now, with high deductible plans being the norm, having access to your insurer’s PRICES is now a significant part of the benefit.
For any not familiar with high deductible plans, essentially you pay the full cost of the first several thousand dollars you incur per year, before insurance starts to cover any of your costs. But you get to pay the insurance company’s rates instead of the fake retail price.
Emergency rooms are required to try and stabilize patients before they discharge them. These patients are billed after they leave the hospital, insured or not.
If I try to schedule a checkup or procedure, I need to give my insurance card first. Uninsured can pay for a flat fee upfront. If they can’t pay, they get no service.
With insurance, things get complicated. The facility will try to give you an estimated cost of the service. But it’s always a back and forth with 2 or 3 parties; the insurance, facility, and doctor network. If there is a disagreement between parties, you the patient get a bigger bill. Even when you payed for the procedure beforehand.
It’s even more fun when, for example, a scan is covered but the person reading the results is not. Or a surgeon and surgery is covered, but the anesthesiologist is not. Or your usual ob/gyn isn’t working when you go into labor at 2am on a Sunday.
Yea, I fucking hate bill balancing. We received a $10,000 bill for a neonatal consult a day after my son was born. He had a little fluid in his lungs, was gone in an hour or two.
The doctor was part of the hospital system but I guess that 2 miles he drove to the women’s center justifies a $10k bill. Our healthcare is broken.
It’s complicated and shitty, but people are treated the same for the most part, there’s no “fast pass” for having better insurance. Hospital and doctors offices are private. You can have private health issues, or if you qualify because you are poor or disabled you can get free health insurance from some states which then pays the hospital or doctor for your care. If you have your own private health insurance through a work group plan or you pay for yourself then you might have to pay a percentage of the total cost called a “copay” or you might have to pay the total cost until you have paid a yearly deductible and then you will only pay a percentage of the total cost until you reach an “out of pocket maximum” for the year which can range from a few thousand to ten thousand or more dollars.
Health insurance implies a middleman that is profit driven to get as much money as possible by denying fringe claims, healthcare is paid for by all and has your health as its driving force.